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What are the options when lung cancer is inoperable?

November is Lung Cancer Awareness Month and for those who have been diagnosed with lung cancer, one dreaded word is inoperable. Many feel defeated when they hear they are not candidates for surgery, but promising non-surgical treatments are available. CyberKnife, a form of stereotactic body radiation therapy (SBRT), is one of these options.

Radiation treatment to a moving target adds a level of complexity. However, CyberKnife tracks a tumor and directs targeted radiation via a state of the art robotic arm. Most patients complete their treatment in 3 to 5 days.

Highly focused radiation has become the standard of care for treating medically inoperable early stage non-small cell lung cancer with excellent results.

This video demonstrates the robotic real-time tracking of the CyberKnife.

Testosterone is associated with worse disease severity in men with early relapsing onset multiple sclerosis

MS and many other autoimmune diseases are less common in men than in women. This is especially true during reproductive years. Sex hormones, including testosterone and estrogen, may be responsible for the difference. It is thought that men with multiple sclerosis may have lower testosterone levels than healthy controls.

Dr. Bove and his group assessed the prevalence and clinical associations of hypogonadism in men with recent onset relapsing multiple sclerosis.  Male subjects from the Comprehensive Longitudinal Investigations of MS at the Brigham and Women's Hospital (CLIMB) cohort were included. Hormonal measures included testosterone, the testosterone: estradiol ratio, leutinizing hormone (LH), and free testosterone. Clinical outcomes were collected every 6 months for Expanded Disease Severity Scale (EDSS), and annually for Symbol Digit Modalities test (SDMT).

The analysis included 96 men with a mean age of 40 years, disease duration of 4.6 years; 71% subjects were untreated at baseline. Of these men, 39% were ...

Life-saving technology and getting the word out about radiosurgery

Twice last week I received phone calls from grateful family members thanking us for taking care of their loved ones when treatment options were dwindling. One patient is now 4 years past his CyberKnife treatment for inoperable lung cancer and is going strong and living life to the fullest. The other patient was recently treated and is feeling great and planning a European vacation. Both families are extremely appreciative for the care they received but both voiced frustration that they stumbled upon this treatment option by chance and that we need to do a better job of publicizing the radiosurgery modalities. As the person receiving these calls, I am thrilled to hear how our center has positively impacted so many lives but struggle with how to get the word out to those who may benefit from radiosurgery in the future. So with our patients’ stories fresh in my mind, here is an introduction to radiosurgery.

Stereotactic radiosurgery is targeted radiation therapy delivered to nearly any body part with precision while utilizing real time image guidance. The ....

Food allergies and emergency epinephrine in Washington State schools

Food allergies have been on the rise in recent years.  Studies suggest that up to 1 in 13 children are affected by a food allergy.  Egg and cow’s milk are the most common food allergies for infants and toddlers.  Fortunately, most children will lose a milk or egg allergy by the time they enter school.  Peanut and tree nut allergies are also becoming more common.  Unfortunately, only 10-20% of children will ever outgrow a nut allergy.

Currently there is no cure for food allergies.  Instead, doctors rely on an accurate diagnosis, avoiding food triggers, and being prepared in the event of a severe reaction.  Making the situation more challenging, nearly half of children with a food allergy may be at risk for a potentially life-threatening reaction called anaphylaxis. 

Symptoms of anaphylaxis may include:

  • hives or itchy welts
  • swelling
  • vomiting or diarrhea
  • difficulty breathing (cough, wheeze or shortness of breath)
  • dizziness or passing out

During a severe food allergy reaction, epinephrine (“adrenaline”) can be a life-saving medication. Epinephrine is typically injected into a thigh muscle with an “auto-injector” device like EpiPen® or Auvi-Q™.  Oral antihistamines like Benadryl, Allegra, or Zyrtec can help with some anaphylaxis symptoms, but are not considered life-saving treatment.

Emergency Epinephrine in Schools

Until recently, only certain students in Washington State could receive a life-saving epinephrine injection while at school.  They needed to be diagnosed with a food allergy and already have an epinephrine injector in the health room.  However, some students may not have an injector at school, or they have their first serious allergic reaction while at school.  In that case, the school could only call 911 and hope they arrived in time to save a life.

In January 2013...

Kids with kidney disease and cold and flu season

With the summer winding down, the dreaded cold and flu season is just around the corner.  Parents with children who have a history of kidney disease need to keep in mind a few things during this season of stuffy noses and coughs.

  • Avoid NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, Motrin, Advil, naproxen, and Aleve.
    • NSAIDs are known to decrease blood flow to the kidneys and can cause more damage.
  • Avoid Pseudoephedrine or any medications that may contain similar ingredients.
    • Pseudoephedrine is usually an ingredient for decongestants like Sudafed and is known to increase blood pressure.
  • Say YES to the flu shot early.
    • Children with kidney disease ....

Can Botox help paraspinal muscle spasticity in multiple sclerosis?

This post is jointly written with Alika Ziker, Swedish Neuroscience Institute research intern.

Botulinum toxin type-A (Botox) is a naturally occurring toxic substance best known for its use in cosmetics.  It is taken from certain bacteria and works by preventing the target muscle from contracting.

Over the last 15 years, several studies have emerged supporting the idea that Botox is also an effective and safe therapy for people who suffer from a loss of muscle control, lower back pain and even migraines. Because multiple sclerosis (MS) is a disease that attacks the central nervous system, many MS patients suffer from those same conditions, as well as weakness and spasticity.  Depending on the individual, the affected muscles may be ....

Do injectable therapies benefit progressive forms of MS?

The American Academy of Neurology (AAN) recently published their Top Five Recommendations in the Choosing Wisely Campaign in promoting high value neurological care. This was done in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports to reduce ineffective and costly care.

One of the AAN’s recommendations was to stop prescribing interferon-beta and glatiramer acetate to people who have progressive, non-relapsing forms of multiple sclerosis (MS).

The AAN made clear that  the recommendations were intended to promote discussion between patients and their providers about the value of these therapies, not to completely stop the use of specific treatments.

The recommendation to stop prescribing interferon-beta and glatiramer acetate is not unanimously supported by all MS neurologists, many of whom feel that this was an oversimplification.

People with ...

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